Internal signs of subsidence: What is subsidence? 5 warning signs every homeowner should know

What is subsidence? 5 warning signs every homeowner should know

With thousands of homes affected every year, subsidence could cost you as much as £250,000 to rectify. Here’s how to spot it and stop it in its tracks…

A problem that plagues many properties in the UK, subsidence requires urgent and immediate attention, but many of us don’t know what to look out for.

READ MORE: Japanese knotweed: removal, identification and treatment

New research carried out by insurers LV= GI found that over half of homeowners falsely identify the signs of subsidence.

Affecting more than just the structural stability of your home, those tell-tale cracks can cost your home up to 20% of its value if left to linger, so it’s important to be able to spot the indicators and effectively treat the root cause before it wreaks real havoc.

In fact, if left untreated, the damage caused could cost you between £3,000 and £250,000 to remedy, according to subsidence and ground instability experts Geobear.

Often built with shallower foundations, old homes can be especially at risk, however, you shouldn’t underestimate the threat posed to newer properties too.

What is subsidence?

In a nutshell, subsidence occurs when the ground underneath a property begins to collapse and takes the building’s foundations with it. This causes one side of the house to sink and those suspect cracks to appear.

Subsidence is a different issue to ground heave, which is when the ground moves upwards rather than downwards, requiring a different course of action.

Many cracks found in homes are harmless. Image: Kwangmoozaa / Shutterstock

Of course, small cracks are a common sight in most properties and not all are a cause for concern. All new builds and home extensions will shift slightly as they settle, so small hairline cracks under 0.5 millimetres in width are normal.

However, larger cracks radiating from windows, doorways or corners can indicate that your property’s foundations have begun to sink – especially if they’ve grown over time.  

How to spot subsidence

Ground engineering specialists Mainmark have outlined five key subsidence warning signs to watch out for:

1. Sinking or sloping floors: this can indicate that the ground beneath your home is collapsing and urgent attention is required.

A dropped floor level can be a cause for concern. Image: iamskyline / Shutterstock

2. Cracks in walls, paths and driveways: take note of any cracks that form a zig-zag pattern following the mortar lines of your home’s brickwork. Cracks caused by subsidence are usually wide enough to fit your little finger into and are visible internally as well as externally.

Keep an eye out for diagonal cracks. Image: eelnosiva / Shutterstock

3. Windows and doors becoming misaligned or jammed: if your home’s foundations are sinking, this can cause problems with cracks around joins – sort this before they develop further.

Subsidence can be common in older properties. Image: Barnes Ian / Shutterstock

4. Skirting boards separating from the wall: visible gaps suggest that your home could be suffering from some serious movement issues that need remedying. 

Monitor your skirting boards for movement. Image: billh28 / Flickr

5. Formation of puddles around the perimeter of your home: this can indicate a problem with drainage. Pooling water can then soften the soil and destabilise the ground beneath your home – more on this below.

Standing water near your home could spell trouble. Image: VDB Photos / Shutterstock

What causes subsidence?

There are some factors that make your home more susceptible to subsidence than others.

The level of moisture in the ground can cause problems. Clay soil especially can shrink, crack and shift during the summer heat, wreaking all kinds of havoc on your foundations. 

Drought-prone areas are more at risk, as the ground is drier and thus more likely to crack, while having an abundance of trees or shrubs close to your home can also dry out the ground as the roots may absorb a lot of water.

But the ground becoming too damp can also be an issue. Leaking drains can wash away or soften the soil, causing it to compress and sink under the weight of your home.

Preventing subsidence

As always, prevention is better than cure and there are a number of steps you can take to lessen the chance of subsidence occurring.

While everyone covets a lovely leafy garden, it’s best to limit the growth of trees and large shrubs to prevent them from drying out the soil.

Make sure any new trees are planted at a distance from your house – take note of the variety you’ve chosen too, as some take in more water than others. If in doubt, go for an evergreen species that won’t absorb as much water.

It’s important to stay on top of the upkeep of your home to prevent drains from flooding and the ground from becoming oversaturated. Check for blocked or leaky drains and keep gutters clear. Especially of concern during the wintertime, check pipes for splits and leaks.

It’s important to keep drains and gutters clear. Image: Suzanne Tucker / Shutterstock

How to fix subsidence

The best course of action is to contact your insurer. They’ll be able to arrange for a full survey to assess your home’s structure. If subsidence is found, there are typically two options available: underpinning and resin injections.

Concrete underpinning requires raising, re-levelling and re-supporting the building with an additional foundation layer. This can be a slow and costly process that may require you to leave the property while work is completed.

A more modern solution is to inject a resin polymer into the ground at certain points. The material expands as it travels into the soil below, filling the gaps. In most cases, a house can be treated in a matter of hours and shouldn’t require you to leave while the work takes place.

Traditional underpinning can be an extensive process. Image: s74 / Shutterstock

Resin injections are usually cheaper than underpinning as it’s a less labour-intensive process and takes less time to complete. However, if there is only a small section of your foundations that require underpinning, the older method may be more cost-effective. Your surveyor will be able to advise.

You’ll then need to fix any cracks that have occurred. Minor ones that don’t affect the structural integrity of your home can often just be filled in and painted over once the cause has been treated. Wider ones that affect the structure itself may require the walls to be repointed and repaired with metal fixings.

READ MORE: 10 warning signs that you’re looking at a money pit

Featured image: eelnosiva / Shutterstock

What are the signs of subsidence (and why you shouldn’t ignore them)

Knowledge is power when it comes to subsidence. If you know the signs to look out for, it will enable you to identify any issues early which will save you time and money in the long run.

So, what are the signs of subsidence?

The main signs of subsidence are:

  • Large cracks in walls
  • Doors and windows sticking and/or becoming misaligned
  • Sinking and/or sloping floors
  • Wallpaper creasing or rippling at joins with no signs of damp
  • Extension cracking or moving away from main property
  • Noticeable leaning of a house

In this article we look at the main signs of subsidence and how to spot them. Secondly, the causes to look out for which may mean your property is at high risk of subsidence. And finally, what to do if you suspect your home may be subsiding.

The key takeaway here is don’t bury your head in the sand if you spot any of the potential signs. Otherwise, it can become difficult to sell a house with subsidence if you let the problems get worse over time…

If you do have subsidence, you can still sell your house. Hit the button below to use our free interactive quiz and get property sale recommendations tailored to you and your situation.

Take this 60-second free quiz for personalised advice on the smartest way to sell your house with subsidence.

  • Avoid the biggest mistakes subsidence sellers make…
  • Don’t settle for a slow and frustrating sale…
  • Find out how to maximise your sale price, and minimise headaches.

What are the main signs of subsidence?

Subsidence occurs when the ground beneath a property begins to sink downwards. The most common causes of subsidence are nearby trees, water leaks and clay shrinkage.

Subsidence can ultimately compromise the structural integrity of your home. It can be expensive and time consuming to fix if left untreated.

With this in mind, it’s important to be aware of the signs of subsidence so you can spot them early and find a resolution before the problems develop.

Let’s look at each of the main signs of subsidence in more detail below…

1. Large cracks in walls

One of the most noticeable signs of subsidence is large cracks appearing in the walls of your home.

Subsidence cracks have some recognisable characteristics, which make them easier to distinguish from other cracks in your home.

Diagonal cracks near windows tend to be a sign of subsidence.

Take a look at our handy “subsidence crack checklist” to help you spot signs of subsidence early.

Subsidence crack checklist

Subsidence cracks tend to be…

Wider at the top and slimmer at the bottom.

Usually more than 3mm wide (thicker than a 10p coin).

Diagonal in shape.

Usually found close to doorframes and windows.

Visible both internally and externally.

If any one or more of the above characteristics are present, you should contact your insurer immediately.

The exception to the above rules is any cracking to a building that could be over the root system of a large tree.

Tim Kenny, a residential building surveyor at Tim Kenny Surveying commented in the RICS Building Surveying Journal that “any cracking to a building that is likely to be over the root system of a large tree should give cause for concern”.

If your home has any cracks which are located near to a large tree in your, or your neighbour’s garden, this should be investigated. Contact your insurer immediately. They will arrange for a qualified structural engineer to visit your house and provide a diagnosis.

Not all cracks mean subsidence

It is important to remember that not all cracks mean subsidence.

Cracks can also appear in your home for a number of reasons, including:

  • Settlement cracks that appear in a new home. Settlement is the natural downward movement of new homes in the first 10 years of its life. It happens when the soil below is evenly compressed by the weight of the building. It’s common to see some minor cracks appearing in the first few years of a new build’s life before the house has stabilised.
  • Hairline cracks that appear on an annual basis. Seasonal hairline cracks can appear in your home. The changing temperature and moisture levels cause the materials of the property to expand and contract. Any cracks that increase in width gradually over time should be investigated though.
  • Cracks in new plaster. Cracks appearing in newly plastered walls will often be down to shrinkage. This happens when the fresh plaster has dried too quickly. So maybe don’t plaster during a heatwave or turn the central heating on to speed up the drying process!
  • Vibrations from traffic. Cracks can form in your home if you live near a particularly busy or fast road. The vibrations from the volume or speed of the traffic directly outside your house is likely to be the cause of a crack rather than subsidence.
  • Lintel failure. Supporting lintels over doors and windows can fail, causing cracks to appear above door frames and windows. The cracks that appear are often diagonal and so can be easily mistaken for subsidence.

Most minor hairline cracks cause aesthetic problems only and are unlikely to indicate a significant structural issue such as subsidence. If you’re in doubt, make sure to contact your insurer who will send out a professional structural engineer to diagnose the problem.

2. Doors and windows sticking

You may have noticed that your doors and windows have started sticking or swinging open on their own accord. Rather than calling ghostbusters, you should get in contact with your insurer. It could be a sign that your house is suffering from subsidence.

The structural instability causes the window frames and doorframes to warp. This means that doors and windows become misaligned and difficult to operate. Look out for cracks or gaps that may also appear around your windows and doorframes.

3. Sinking floors

Sinking or sloping floors can indicate that the ground beneath your property is collapsing.

Sinking floors can be another sign of subsidence.

If any gaps start to appear beneath your skirting boards, act immediately and contact your insurer to discuss next steps.

Sloping floors are commonly found in older properties. They may only indicate past movement, rather than an ongoing subsidence problem. If you are thinking of purchasing a property with sloping floors, ensure you obtain a report from a structural engineer to put your mind at rest.

4. Wallpaper creasing with no signs of damp

If you notice your wallpaper creasing or rippling where the wall meets the ceiling, it could be a sign of subsidence. The most likely cause is damp, but if there are no signs of damp then consider whether subsidence could be the culprit.

The same thing can happen with tiled walls. Look out for cracks appearing in grout or gaps appearing between tiles.

5. Extension moving away from home

Another tell-tale sign of subsidence is your extension moving away from your home or cracks appearing where the extension meets the house.

Properties built in the Victorian and Edwardian eras tend to have simple shallow foundations. Newer extensions will have deeper foundations to comply with the Building Regulations introduced from the mid-1960s onwards.

Both parts of the property will usually be built with different materials too. The extension will be built with more rigid materials, whereas older properties tend to be built with more flexible materials.

When there’s a lack of consistency in foundation depth and materials used, the two parts of the home can move at different rates and therefore cause damage and cracking. This is especially true when the home is built on cohesive soils.

6. Noticeable leaning of the property

The last sign of subsidence is when a house is noticeably leaning.

However, this doesn’t always mean that subsidence is an ongoing problem. The subsidence issue could be historic, meaning the building has now stabilised and may not have moved in years.

If a house is noticeably leaning, it doesn’t always mean that subsidence is an ongoing problem.

If you are thinking of purchasing a property and think one or more of the walls look noticeably wonky, make sure to get a structural engineer out to the property to take a look. They will be able to tell you if the subsidence is ongoing or historic and nothing to worry about.

Remember though that purchasing a house with historic subsidence may make it harder to sell in the future and/or obtain insurance. Read more about subsidence and insurance here.

Is my property at high risk of subsidence?

Although it isn’t possible to accurately predict what houses will suffer from subsidence, there are certain factors that may mean your property is at high risk of subsidence.

Being aware of what can cause subsidence will mean you are better equipped to spot early signs. The earlier subsidence is spotted, the easier it is to fix. Remember, subsidence won’t go away on its own so don’t ignore the warning signs.

Your property may be at a higher risk of subsidence if any one or more of the following apply:

  • Property built on cohesive soils (such as clay and silt). Cohesive soils can absorb large quantities of water and so will swell and shrink depending on the moisture content of the soil. In prolonged dry spells of weather, the soil can shrink to such a level that will cause the foundations underneath your home to shift. Cohesive soils are most common in the South East of England, particularly Greater London.
  • Trees close to your property. Trees disturb the ground beneath your home’s foundations by drawing up significant volumes of water from the soil, especially during periods of drought. Thirsty trees such as oak, willow, ash, poplar, plane and sycamore trees that are planted closer than the recommended “safe distance” to your home can mean your property is at a greater risk of subsidence.
  • Property located in mining areas. Mining can cause subsidence when the earth beneath or surrounding your home’s foundations has been weakened by the collapse of underground mines or from historic mining works.
  • Older properties with extensions. When there is a lack of consistency in foundation depth, the two parts of the home can move at different rates and therefore cause damage and cracking.
  • Property with poorly maintained pipes, drains and gutters. Water leaks can wash away fine particles in the soil underneath the foundations of your home if it’s built on non-cohesive soil (such as sand and gravel). If your home is built on cohesive soil, water leaks can saturate the soil. Foundations can either give way and subside or rise, causing another type of ground movement called heave.

You can read more about the 6 most common causes of subsidence and how to reduce the risk here.

What is the first thing I should do if I spot signs of subsidence in my home?

If you spot signs of subsidence, make sure you inform your insurer as soon as possible. It’s best to be proactive when it comes to subsidence. Problems left untreated can result in more extreme, time consuming and expensive repairs.

Your insurer will arrange for a professional structural engineer (typically one registered with The Institution of Structural Engineers) to visit your property and accurately diagnose the issue.

You should expect to pay around £700 – £1,000 for a professional structural survey.

You should expect to pay around £700-£1,000 for a professional structural survey. The cost will be covered by your insurance, but in reality your excess for a subsidence claim is likely to be about the same amount. This means that (in most cases) you should expect to foot the bill.

Once the final report has been filed, most insurers will then arrange the repairs with their approved contractors – and ultimately cover the cost of them.

Is subsidence expensive and time consuming to fix?

Subsidence can be expensive and time consuming to fix, but every case is different.

Although the average cost to repair subsidence is around £6,000-£14,000, most (but not all) insurers will cover the cost. This will leave you with just an excess to pay of around £1,000.

However, costs can be drastically higher for more severe cases of subsidence, sometimes reaching as high as £50,000. Unfortunately, not all insurance policies will cover subsidence either. This is why it’s so important to be aware of the signs so you can spot subsidence early before the bills start to rack up!

The building work needed to fix subsidence can take as little as two days, or as long as 6 weeks. This will depend on the size of the area affected, plus the extent and severity of the problem.

However, a subsidence issue can take over a year to resolve when you factor in the time waiting on structural reports, gathering building quotes and negotiating with your insurance company.

Will I be able to sell a home with subsidence?

It is possible to sell a property with subsidence, but it can be trickier and more time consuming than selling a problem-free property.

I designed this short quiz to help you determine your best way forward if you want to sell the property.

Take this 60-second free quiz for personalised advice on the smartest way to sell your house with subsidence.

  • Avoid the biggest mistakes subsidence sellers make…
  • Don’t settle for a slow and frustrating sale…
  • Find out how to maximise your sale price, and minimise headaches.

Remember you have to declare subsidence to prospective buyers, even if it is historic.

For many people, your best option will be selling by auction. Auction can offer a faster and more certain sale, and potentially get you a better selling price. If you think this could be a good option for you, read “My Guide To Finding The Best Auction House In The UK” here.

Over the last few years, I have spoken with and helped many dozens of people with both ongoing and historic subsidence issues of different severities and causes. If you would like to read more about how I can help you, take a look at my Auction Case Study: Finding out your property has subsidence…when you’re 9,000 miles away.

Accelerated ESR syndrome in outpatient hematology practice + audio

An increase in erythrocyte sedimentation rate (ESR) in women younger than 50 years old is noted at a value of more than 15 mm/h, over 50 years old — more than 30 mm/h; in men younger than 50 years old – more than 10 mm / h, over 50 years old – more than 20 mm / h.

Mechanism of origin The most important property of blood plasma that affects this indicator is its viscosity. It increases with a shift in the protein spectrum towards coarse proteins. This occurs primarily with an increase in the amount of fibrinogen, the main stabilizer of erythrocyte suspension. An increase in plasma of other globulins (γ-globulins, α2-globulins) also leads to a drop in the electrical charge of erythrocytes and contributes to their aggregation. ESR also depends on the number, size, volume of red blood cells, on the concentration of hemoglobin in them. The fewer of these cells, the faster they settle in the capillary.

In men, on average, the number of red blood cells is higher than in women, so the ESR in the latter is higher. It also increases at low temperatures. With regard to physiological conditions, pregnancy is accompanied by a significant acceleration of ESR (up to 30–40 mm/h). In 1984, L. Wilson et al found that in healthy elderly people this figure can reach 50–60 mm/h.

With an increase in the level of bile acids in the blood, the ESR slows down. Severe hypofibrinogenemia, for example, in severe liver damage, may prevent an increase in ESR even with significant dysproteinemia. It is slowed down by an increase in the partial tension of CO2 in the blood, as well as erythrocytosis.

When there is an accelerated ESR

bacterial infections,

  • immune inflammation,
  • aseptic inflammation,
  • viral infections.
  • 2. Blood diseases:

    • anemia,
    • paraproteinemic hemoblastoses,
    • other forms of hemoblastoses.

    3. Malignant tumors.

    4. Metabolic diseases:

    • amyloidosis,
    • diseases occurring with impaired fat metabolism.

    Inflammatory diseases

    An increase in ESR is associated with the development of dysproteinemia, the appearance in the bloodstream of tissue decay products, C-reactive protein, immune complexes and other components that change blood viscosity and the potential of the erythrocyte membrane. In bacterial infections, the severity of this process is often determined by the severity of the pathology.

    With purulent inflammation, abscesses of various organs, ESR is significantly accelerated. Sometimes its indications lag behind the clinical development of the disease, which is especially evident in acute inflammatory conditions. At the same time, there is no direct relationship between the indicators of ESR, body temperature and leukocytosis. ESR increases relatively more slowly and also decreases to normal compared to the number of leukocytes and clinical manifestations of the disease.

    For example, in acute tonsillitis, the maximum acceleration of ESR is most often observed during a decrease in body temperature and the reverse development of the inflammatory process in the tonsils. Nevertheless, for most of the common inflammatory diseases such as acute appendicitis, cholecystitis, pyelonephritis, pneumonia, the degree of ESR acceleration is characteristic, which correlates with the severity of the pathological process, although it occurs later than leukocytosis and fever appear.

    In chronic inflammatory conditions, an increase in ESR is more often and more stable than fever and leukocytosis.

    Sometimes chronic indolent infections of the biliary tract, urinary system, oral cavity and other localizations occur latently, and the acceleration of ESR is one of the few or even the only symptom that allows one to suspect the presence of a chronic focus of infection. Encapsulation of the inflammatory focus, in which the decay products do not enter the blood, is not always accompanied by an increase in ESR, in contrast to the rapid entry of necrosis products into the bloodstream. For active tuberculosis, an acceleration of ESR is typical, combined, as a rule, with moderate leukocytosis and lymphopenia.

    Most specific bacterial infections are associated with increased ESR. Difficulties in diagnosis arise in latent infections that are not accompanied by a clear clinical picture. It is necessary to identify a latent infection that affects the teeth, tonsils, paranasal sinuses, bile ducts, kidneys, and female genital organs. In addition to persistent acceleration of ESR, moderate leukocytosis can be determined, sometimes with a shift of the leukocyte formula to the left. C-reactive protein appears in the blood serum, the amount of sialic acids increases, dysproteinemia is possible, mainly due to a moderate increase in globulins of various fractions. Sometimes functional disorders are found on the part of the organs involved in the inflammatory process. Immune inflammation covers a large group of different diseases with primary or secondary immunopathological reactions. In some cases, exposure to an infectious agent that initially causes infectious inflammation subsequently triggers a chain of immunological phenomena.

    Rheumatism is a common cause of increased ESR. The level of this indicator correlates with the activity of the rheumatic process, with the severity of the exudative phase of inflammation. A significant acceleration of ESR is typical for all systemic diseases of the connective tissue and is often consistent with the activity of the course. With these diseases, cryoglobulins sometimes appear in the blood, which sharply increase blood viscosity and reduce ESR. Immune diseases of the kidneys also lead to an increase in it. This is typical for nephrotic syndrome of various origins due to pronounced dysproteinemia and hypercholesterolemia, often hyperfibrinogenemia.

    Significant acceleration of ESR has been described in sarcoidosis. Aseptic inflammation also leads to this. It occurs under the influence of various exogenous physical and chemical factors (irradiation, burns, injuries, exposure to acids and alkalis, etc.). In such cases, the rapid addition of infection is possible.

    A typical example of aseptic inflammation is the so-called resorption-necrotic syndrome in acute myocardial infarction, in which, in particular, ESR increases 1–2 days after the onset of leukocytosis and fever. Moreover, the acceleration is maintained until the complete healing of the infarction.

    Dynamics of ESR, as well as leukocytosis and fever, has a certain diagnostic and prognostic value. Sometimes this suggests the addition of various complications.

    Viral infections, unlike bacterial infections, are rarely accompanied by a significant increase in ESR. In acute viral infections of the respiratory tract, primarily with influenza, a moderate acceleration of ESR is delayed and is often recorded for the first time against the background of already declining body temperature and the regression of the clinical manifestations of the disease. Viral pneumonia often occurs without ESR acceleration.

    Viral hepatitis is characterized by a moderate acceleration of ESR in the preicteric period, a decrease in ESR to normal and even lower as jaundice appears, and an increase again when jaundice disappears with a gradual return to normal upon recovery. Long-term preservation of a moderately accelerated ESR indicates the persistence of the virus or the addition of a bacterial infection of the biliary tract.

    Infectious mononucleosis is accompanied by normal or slight accelerated ESR in combination with leukocytosis and the presence of polymorphic cells with a large nucleus in the blood.

    The majority of acute viral infections occur with normal or even reduced ESR in combination with moderate leukopenia and relative or absolute lymphocytosis.

    Blood diseases

    An increase in ESR in anemia is a typical symptom associated primarily with a decrease in the number of red blood cells, although often present dysproteinemia also plays a role. There are calculations and nomograms that determine the proper ESR values ​​depending on the number of red blood cells.

    It is believed that if the ESR is increased compared to the calculated value, then this may be associated with other severe pathologies that cause anemia (infectious disease, tumor, collagenosis, kidney pathology, etc.). On the contrary, if ESR is accelerated to a lesser extent, then some authors attribute this to favorable signs of the regenerative nature of anemia (for example, this situation is sometimes observed in reticulocyte crisis in patients with B12 deficiency anemia).

    With microspherocytic anemia, there may not be a significant increase in ESR, since the morphological features of erythrocytes in this condition prevent their agglomeration. To diagnose the type of anemia, it is necessary to take into account the history, clinic, changes in blood tests, bone marrow, instrumental data (ultrasound, endoscopic examination of the gastrointestinal tract).

    Acceleration of ESR is noted in 85% of patients with multiple myeloma due to hyperviscosity syndrome. This diagnosis is made if more than 10% of plasma cells are found in the bone marrow and paraprotein is present in the blood serum and/or urine. In Bence-Jones myeloma, when only light chains are secreted, ESR may remain within normal limits unless there is severe anemia. The second most common, but very rare paraproteinemic hemoblastosis is Waldenström’s macroglobulinemia, for which, unlike multiple myeloma, osteolytic processes are not typical. On the other hand, hepatosplenomegaly, lymphadenopathy and a pronounced syndrome of increased blood viscosity are typical. Last manifested:

    • bleeding of mucous membranes,
    • hemorrhagic retinopathy,
    • retinal veins,
    • Raynaud’s syndrome,
    • ulceration and gangrene of the distal extremities,
    • paraproteinemic coma,
    • macroglobulinemic retinopathy.

    The criteria for the diagnosis of Waldenstrom’s macroglobulinemia are the presence of a mixed cell substrate in the bone marrow (plasma cells and lymphocytes), the detection of monoclonal macroglobulinemia, fibrosis in the trepanate.

    Heavy chain diseases (HCDs) are B-cell lymphatic tumors. There are options: BTC-γ, BTC-α, BTC-δ, BTC-μ.

    With BTC-γ, the average age of patients is 60 years, but can also occur in children. The clinical picture includes: fever, night sweats, weakness, weight loss, lymphadenopathy, splenomegaly, hepatomegaly, damage to the pharyngeal lymphoid ring, recurrent infections, damage to the thyroid gland, salivary glands, skin, subcutaneous tissue, autoimmune processes (25%) with a clinic of rheumatoid arthritis, systemic lupus erythematosus, autoimmune hemolytic anemia , thrombocytopenia, thyroiditis, Sjögren’s syndrome and others. The bone marrow is affected in 50% of cases. This nosological form does not have a specific histological picture. In the immunochemical diagnosis of BTC-γ, the secretion of heavy chain fragments of PIgG subclasses is determined, serum PIg is present in the urine (proteinuria overload), Bence-Jones protein is usually absent.

    BTC-α is more common in children and young patients under 30 years of age. There are 2 options: abdominal and pulmonary. In the first case, there is a syndrome of impaired absorption (chronic diarrhea, steatorrhea, exhaustion, edema, hypocalcemia, hypokalemia, baldness, amenorrhea), fever, bouts of abdominal pain. Pulmonary form accompanied by bronchopulmonary lesions , mediastinal lymphadenopathy. In the immunochemical diagnosis of BTC-α, fragments of α-chains are determined in blood serum and urine, in the contents of the duodenum and small intestine, in saliva. The Bence-Jones protein in BTC-α is never registered. Described benign monoclonal gammopathy, which are manifested only by the syndrome of increased ESR and are determined biochemically. Sometimes the existence of such gammopathy is possible throughout the life of the patient. But in some cases, gradually, sometimes after decades, the clinical picture of myeloma or other malignant process develops.

    As for other forms of hemoblastosis, an increase in ESR is characteristic of all acute and chronic leukemias, malignant lymphomas, including Hodgkin’s lymphoma. For diagnosis, in addition to the study of the hemogram, sternal puncture and / or trepanobiopsy are necessary. To determine the various forms of lymphomas, it is necessary to conduct a histological, enzyme-linked immunosorbent assay of biopsy material, and genetic studies. To clarify the localization of lesions of the lymph nodes and internal organs, ultrasound of the abdominal cavity, CT of the chest are used.

    Malignant tumors

    The increase in ESR in this case is associated not only and even not so much with the severity of anemia, but with dysproteinemia, an increase in the amount of fibrinogen and a change in the charge of the erythrocyte membrane. More often, persistent and significantly accelerated ESR is observed in cancer of the bronchus, bones, ovary, hypernephroma, sarcomas, less often in tumors of the gastrointestinal tract. Although with cancer of the stomach, large intestine, pancreas, liver, a significant increase in ESR is also sometimes found. Its value depends on the histological structure of the tumor, but to a greater extent is determined by the size of the neoplasm and the presence of complications. In some cases, an increase in ESR is at the first stage the only manifestation of malignant growth, ahead of clinical symptoms.

    Other indicators of peripheral blood may change with the development of the tumor: anemia is often observed (less often secondary erythrocytosis), in some cases neutrophilic leukocytosis, lymphopenia, monocytosis, hyperthrombocytosis are noted. If a neoplasm is suspected and there are no clear clinical manifestations, a thorough and systematic examination is necessary: ​​sternal puncture (detection of signs of hemoblastosis or anemia as the cause of an increase in ESR), abdominal ultrasound, CT and X-ray examination of the lungs, bronchoscopy, FGDS, FCS. You should consult with an obstetrician-gynecologist and urologist.

    Metabolic disorders

    Most often, an increase in ESR is observed in tissue dysproteinoses. This process may be associated with some forms of hyperlipidemia, widespread atherosclerosis. The main reasons for the increase in ESR in metabolic diseases are dysproteinemia, hypercholesterolemia.

    Amyloidosis leads to its acceleration due to severe dysproteinemia. The most common is secondary amyloidosis, which complicates the course of chronic suppurative lung diseases, tuberculosis, chronic osteomyelitis, ulcerative colitis, Crohn’s disease, and systemic connective tissue diseases. Paraproteinemic hemoblastoses can lead to the occurrence of this lesion. Amyloid deposition is possible in all organs and tissues. Parenchymal organs are most often affected: kidneys, liver, spleen, adrenal glands, less often – gastrointestinal tract, cardiovascular system, lungs, thyroid gland, etc.

    There are 4 stages of renal amyloidosis: latent, proteinuric, nephrotic and azotamic. The first is dominated by the symptoms of the underlying disease, potentially dangerous in relation to amyloidosis. Sometimes a slight proteinuria appears and a persistent, significantly increased ESR is recorded, which is often not explained by the activity of the course of the underlying pathology. Already at this stage, an enlarged liver and spleen can be palpated, the deposition of amyloid in which is most often found in secondary amyloidosis.

    Advanced stage is manifested by complete nephrotic syndrome (proteinuria more than 3 g per day, hypoproteinemia, hyperlipidemia, edema). In the future, symptoms of chronic renal failure appear and progress. In some patients, amyloid is deposited predominantly in the liver. This is characterized by moderate pain in the right hypochondrium, flatulence, sometimes jaundice. The liver can be enlarged very significantly and descend into the small pelvis. In rare cases, there may be a predominant deposition of amyloid in the adrenal glands with a gradual development of the clinical picture of hypocorticism up to the advanced symptoms of chronic insufficiency of the adrenal cortex: increasing weakness, adynamia, persistent decrease in blood pressure, nausea, vomiting, diarrhea, hyperpigmentation of the mucous membranes of the lips and skin on open parts of the body and in the area of ​​\u200b\u200bthe folds, the extinction of sexual function. Any exposure (intercurrent infection, trauma, etc.) can trigger an adrenal crisis. At the same time, all of the above symptoms increase. Abdominal pains, indomitable vomiting appear, dehydration progresses rapidly, convulsive syndrome, oliguria and acute renal failure occur. As a result, a coma develops, and the patient dies. Even more rarely, the predominant deposition of amyloid is noted in the intestine. Clinically, this is manifested by pain syndrome, intestinal atony, persistent diarrhea. Sometimes bleeding is possible.

    A persistent and significant increase in ESR as an early symptom is characteristic of primary (idiopathic) amyloidosis.

    The most typical lesions are the skin (itching, petechiae, age spots, urticaria, sometimes dense swelling that makes the face mimic), muscular and nervous systems (muscle pain, stiffness, muscle thickening, sometimes their atrophy, paresthesia, less often – polyneuropathic syndrome, epileptiform seizures, psychotic reactions). In contrast to secondary amyloidosis, damage to parenchymal organs is less common in primary amyloidosis. Selective deposition of amyloid in any organ is possible. Various forms of hereditary amyloidosis caused genetically are also described.

    A persistent increase in ESR is typical for senile amyloidosis , which is manifested by a triad of Schwartz symptoms: damage to the heart (heart failure progresses), brain damage (different types of dementia) and amyloid deposition in the islets of Langerhans of the pancreas with the development of symptoms of diabetes mellitus. All forms of amyloidosis are characterized by hypercholesterolemia and hyper-β-lipoproteinemia occurring in the nephrotic stage of renal amyloidosis. With the defeat of the latter, episodic small proteinuria is noted already at an early stage, then it increases and usually exceeds 3 g per day. Proof of amyloidosis is possible by biopsy of various organs and tissues, followed by histological and histochemical examination of the biopsy.

    Diseases that occur with a violation of fat metabolism, in particular, widespread atherosclerosis, with hypercholesterolemia, can cause a persistent, often moderate, sometimes significant increase in ESR.

    Patients with severe atherosclerosis, weight loss, accelerated ESR sometimes show predominant signs of atherosclerotic lesions of the brain vessels (headache, noise in the head or ears, dizziness, syncope, sleep disorders, memory, changes in the emotional sphere, mental disorders; cerebral vascular crises), and symptoms of damage to the coronary arteries, aorta, arteries of the lower extremities can be moderately expressed.

    Hypercholesterolemia accompanies a variety of diseases, especially common in some forms of liver cirrhosis, with nephrotic syndrome of any nature. An increase in ESR in these cases is associated not only with it, but also with severe dysproteinemia. Hypercholesterolemia is typical of hypothyroidism, which can increase ESR. It is also characteristic of some hereditary forms of hyperlipidemia, contributing to the development of atherosclerosis, for some lipidosis and glycogenosis, often accompanied by a moderate increase in ESR.

    A significant acceleration of ESR occurs with generalized xanthomatoses, in particular, with Burger-Grutz syndrome, or hypercholesterolemic xanthomatosis (a disease of middle-aged people; typical tuberous xanthomas on the face, extremities and mucous membranes, hepatosplenomegaly, chronic pancreatitis, CNS damage) and Harbitz-Muller syndrome, or familial hypercholesterolemia (external xanthomas, xanthomatous vascular changes that can lead to changes in various organs). This process is also described in Urbach-Wite syndrome, or mucocutaneous lipoid proteinosis (hyalinosis of the skin and mucous membranes). Typical nodular deposits in the skin, oral cavity, vocal cords (which leads to persistent hoarseness), dysphagia. Possible damage to the central nervous system with epileptiform seizures and mental infantilism. Disorders of fat and carbohydrate metabolism are revealed.


    Summarizing, we can say that in order to get an idea of ​​the possible volume of “diagnostic search” with increased ESR as a leading sign, it is necessary to obtain detailed anamnestic information. Examination of a patient with an incomprehensible acceleration of ESR requires attention to the main “hot” spots: the size and consistency of the lymph nodes, careful palpation of the spleen, kidneys, auscultation of the heart, lungs, etc. The doctor must have laboratory and instrumental data.

    norm for men and women, interpretation of blood test, high and low values ​​

    Medicine and health

    Where can I return it and how much will it cost

    Erythrocyte sedimentation rate (ESR) is an analysis during which blood is poured into a long glass tube with divisions and left for an hour.

    And then they measure how many erythrocytes – red blood cells – managed to settle to the bottom of the tube. Sometimes this analysis is done automatically, but the principle remains the same.

    Daniil Davydov

    specialist in clinical and laboratory diagnostics

    Author profile

    Go to the doctor

    Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don’t write prescriptions, we give recommendations. Relying on our point of view or not is up to you.

    When the blood is inside a person, it moves very quickly through the vessels and is constantly mixed. Red blood cells are evenly distributed in plasma, the liquid component of blood, so fresh blood looks like red paint. But if you pour blood into a test tube, after a while it will stratify: yellowish plasma will appear on the surface of the test tube, and erythrocytes will sink to the bottom under the influence of gravity and turn into a red precipitate.

    In healthy people, the surface of red blood cells is negatively charged, so they repel each other. And since erythrocytes are very light, they are suspended in the plasma and therefore settle slowly.

    Erythrocyte sedimentation rate – an international textbook for laboratory technicians

    How ESR works – US pediatric journal

    If there is no inflammation, red blood cells do not stick together and settle slowly

    If something is wrong with the body, proteins may appear in the blood plasma that are not normally there – or are, but very few. For example, with many external and internal injuries, the concentration of protective proteins-immunoglobulins and fibrinogen, a protein that “sews up” wounds, increases in the blood. Fibrinogen and immunoglobulins stick to the surface of red blood cells, causing them to stick together into heavy lumps. As a result, in people with an inflammatory process in their body, red blood cells sink faster than in healthy people.

    The method is based on this simple idea: if a red precipitate appeared in the test tube faster than expected, then there was an increase in ESR. There is a lot of excess protein in the blood. This may indicate that somewhere in the body there is a latent inflammation.

    If there is inflammation, red blood cells stick together into lumps and quickly go to the bottom

    You will find out

    • Why ESR is prescribed
    • How ESR is done: analysis methods
    • ESR norms
    • What does ESR mean: decoding analysis
    • How to take an ESR test

    Why ESR is prescribed

    To detect inflammation. As a rule, doctors prescribe an analysis if a person has symptoms that make it possible to suspect a latent inflammatory process:

    1. headache;
    2. temperature above 37°C;
    3. joint stiffness;
    4. neck or shoulder pain;
    5. unexplained weight loss;
    6. loss of appetite.

    Why ESR is prescribed – MedlinePlus 9 International Medical Encyclopedia0005

    In addition, ESR is prescribed if tests reveal anemia – when the number of erythrocytes or the concentration of the main respiratory protein, hemoglobin, decreases in the blood.

    An article that high ESR is rarely wrong – Pubmed

    Features of ESR as a research method – Association of Clinical Laboratory Diagnostics (AACC)

    At the same time, ESR does not help to figure out what caused the inflammation. In international medical practice, this analysis is used as an auxiliary method in the diagnosis of only three inflammatory diseases, in which the ESR rises very much – more than 100 mm / h:

    1. Temporal arteritis is a chronic inflammation of the large arteries of the face and head.
    2. Systemic vasculitis – inflammation of the blood vessels throughout the body.
    3. Polymyalgia rheumatica – muscle inflammation.

    In all other cases, ESR can only hint that something is wrong with health – and perhaps the cause is inflammation.

    The fact is that the erythrocyte sedimentation rate, in addition to inflammation, is affected by many other conditions: from changes in the size and shape of erythrocytes, as is the case with sickle cell anemia, to pregnancy, diabetes and cardiovascular diseases, in which the level of fibrinogen in the blood also increases.

    To avoid such confusion, in modern laboratory practice, ESR is increasingly supplemented or even replaced by direct measurement of specific proteins that appear in the midst of an inflammatory response, such as C-reactive protein. So there is less chance of confusing inflammation with the characteristics of the body.

    When ESR works worse than C-reactive protein

    To see if treatment helps. In most cases, ESR is prescribed not so much for diagnosis as for monitoring the treatment of inflammatory diseases. If the ESR decreases, then the treatment is helping.

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    How ESR is done: methods of analysis

    ESR is one of the oldest laboratory tests in the world. Back in the late 18th century, British military surgeon John Hunter discovered that sick people develop blood sediment faster than healthy people. Why this happens, the doctor did not know, but he wrote about it in an article that was published after his death.

    History of ESR – an international library for doctors StatPearls Publishing

    In the 19th century, the idea was picked up and developed by the Polish physician Edmund Bernacki. He suggested that it could be a change in the protein composition of the blood. And at the beginning of the 20th century, two Swedish doctors – Robert Fareus and Alf Westergren – found that ESR helps predict the outcome of tuberculosis, and proposed a method for measuring erythrocyte sedimentation, which is still used almost unchanged by laboratories around the world.

    ICSH Guidelines for Erythrocyte Sedimentation Measurement – Latest Edition 1993

    There are several other methods for measuring erythrocyte sedimentation rate in laboratory diagnostics. They all take an hour, but their results differ from each other.

    Westergren method . 2 ml of venous blood is taken from the patient into a special vacuum tube, mixed with an anticoagulant and sucked into a graduated thirty-centimeter glass tube – for analysis, blood is collected up to the mark of 200 mm, that is, ⅔ of the tubes are filled. Then the tube is placed vertically in a special stand and left for an hour. The result is fixed either manually or automatically in special analyzers.

    The International Council for Standardization in Hematology (ICSH) has recognized the Westergren method as the reference method for measuring ESR. Most of the international clinical guidelines and textbooks are based on the results obtained by this particular method, also because the study is done on venous blood.

    GOST R 53079.4-2008 – how to achieve the best test results

    Blood from a vein is considered the most suitable for laboratory research, because microclots can form during the collection of capillary blood, which can affect the results of the analysis.

    Wintrobe method. This is a modified Westergren method, in which the blood is not diluted, but 10 cm long tubes are used for analysis.

    The Wintrobe method is used mainly abroad and is much less common than the Westergren method, because it is considered less accurate.

    Panchenkov method. Approximately 100 µl of blood is taken from a patient from a finger directly into a thin glass tube 17.2 cm long, pre-washed with an anticoagulant. Then the blood is poured onto the glass, mixed with an anticoagulant and sucked back into the tube to a level of 10 cm – and so on four times. In the end, the tube is placed vertically in the rack and left for an hour.

    The Panchenkov method uses capillary blood and is therefore considered less accurate than the Westergren method. Applicable only on the territory of Russia and the CIS countries. Some private laboratories indicate that they do analysis according to the Westergren method, but from capillary blood – so, most likely, this is a modification of the Panchenkov method.

    ESR norms

    ESR norms obtained by the Westergren and Panchenkov methods are similar – however, in the zone of elevated values, the ESR measurements are slightly different. The tube used in the Westergren ESR measurement is longer than the tube used in the Panchenkov method. So when using the first method, the results can also be higher.

    Why the results obtained by different methods may differ – the post of the clinic of evidence-based medicine “Rassvet”

    ESR norms according to Panchenkov and Westergren

    According to the Panchenkov method Westergren
    ESR – the norm in children under 11 years old 4-11 mm/h 2-10 mm/h
    ESR – the norm in men under 50 years old 1-10 mm/h 2-15 mm/h
    Over 50 1-10 mm/h 2-20 mm/h
    ESR – the norm in women under 50 years old 2-15 mm/h 2-20 mm/h
    Over 50 2-15 mm/h 2-30 mm/h

    ESR norms

    According to the Panchenkov method

    ESR – the norm in children under 11 years old

    4-11 mm / h 90 005

    ESR – the norm for men under 50 years old

    1-10 mm/h

    Over 50 years old

    1-10 mm/h

    ESR – norm in women up to 50 years old

    2-15 mm/h

    Older than 50 years

    2-15 mm/h

    Westergren method

    Children up to 11 years old

    2-10 mm/h

    Men up to 50 years old

    2-15 mm/h

    Men over 50

    2-20 mm/h

    Women under 50

    2-20 mm/h

    Women over 50

    900 02 2—30 mm/h

    Before donating blood, it makes sense to ask what method the selected laboratory plans to measure ESR. It will be necessary to repeat the analysis either in the same laboratory or in another, where the ESR is measured in the same way.

    What does ESR mean: analysis decoding

    ESR is too “vague” analysis to draw any conclusions about the state of health based on it. Doctors call such tests non-specific, and it makes sense to decipher the results only in conjunction with the results of other studies, for example, with a general blood test.

    How to understand the results of the ESR analysis – Mayo Clinic

    However, the result of the analysis may lead the doctor to certain suspicions.

    Causes of increased ESR. The indicator increases in diseases and conditions when the amount of protein in the plasma increases. This occurs with any inflammation, as a rule, due to immunoglobulins – immune proteins that protect the body from microbes and cancer cells. The number of immunoglobulins also increases with immune system errors, that is, with autoimmune diseases.

    Therefore, high ESR values ​​may indicate, for example, the following problems:

    • bacterial infection;
    • oncological diseases, such as multiple myeloma or Waldenström’s macroglobulinemia;
    • autoimmune diseases such as lupus, rheumatoid arthritis or polymyalgia rheumatica.

    What to do if the reasons for the increase are not determined. ESR is a non-specific indicator. It can change in many different diseases: from anemia and coronary heart disease to diseases of the kidneys and thyroid gland.

    Therefore, if the ESR is very abnormal, it makes sense to discuss the results with a doctor, for example, with a therapist. If necessary, the specialist will prescribe additional tests and examinations that will help identify the cause. It is impossible to make an accurate diagnosis based only on ESR.

    Causes of ESR decrease. The indicator may decrease:

    1. For physiological reasons, for example, in athletes with moderate and high physical exertion.
    2. With polycythemia – when there are so many red blood cells in the blood that it becomes too viscous.
    3. For hemoglobinopathies that cause red blood cells to change shape, such as sickle cell anemia, when the red blood cell becomes like a crescent, or macrocytic anemia, when the red blood cell resembles a ball.
    4. People who use certain medications, such as non-steroidal anti-inflammatory drugs or statins.

    How to lower the ESR in the blood. When the treatment is directed at the cause of the disease that led to an increase in ESR, the level of protein in the blood will return to normal by itself. You don’t need to do anything special for this.

    How to take an ESR test

    How to prepare . Abroad, it is believed that it is not necessary to prepare for a blood test for ESR. Domestic laboratory assistants believe that the analysis will be more accurate if you donate blood in the morning on an empty stomach or at any time during the day, but at least three hours after eating. You can drink clean water before analysis.

    How much does it cost. You can take a blood test for ESR free of charge under the CHI policy – it is usually prescribed together with a detailed general (clinical) blood test. The alternative is a private laboratory.

    You have the right to free tests according to compulsory health insurance

    Almost all laboratories take blood for ESR. The price in the network laboratory will depend on the region: it will cost more for residents of Moscow and the Moscow Region. We indicate prices together with the taking of biomaterial.

    Citylab Laboratory Westergren method:

    1. Moscow and Moscow Region — 270 R.
    2. Samara — 180 R.
    3. Novosibirsk — 120 R. 9004 2

    Laboratory KDL by Westergren’s method:

    1. Moscow and Moscow Region — 270 R.
    2. Novosibirsk — 155 R.
    3. Voronezh — 105 R. 9004 2

    Laboratory “Invitro” according to the Panchenkov method:

    1. Moscow and Moscow Region – 295 R.